Are slow reimbursements, Medi-Cal complexities, and IPA billing rules impacting your revenue cycle? Get customized medical billing services in California based on unique payer mix and specialty. Our billing team works with California-specific rules from Medi-Cal's six-month billing limit to the latest 30-day prompt-pay law. We help submit clean claims the first time. With human oversight and AI-powered tools, MedCare MSO helps you improve revenue cycle and collect more payments.
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Up to 35%
Revenue Increase
96%
Collection Ratios
50+
Billing Specialties
98.5%
Clean Claims
Empower your California practice with efficient RCM, reduced backlogs, and improved revenue performance.
Request a Callback35%
Reduction in A/R
We understand that running medical practices is challenging and can often become a time-consuming and complex process. Efficient front office processes, including patient intake, check-in, and insurance verification, are crucial for smoother billing workflows. Our expert medical billers and coders can help by taking over your administrative tasks, dealing with insurance companies, and providing the support and flexibility your practice needs while freeing up your valuable time so you can focus on your patients.
Our medical billing and coding specialists are proficient at minimizing denials and accelerating reimbursements, ensuring you receive the payments you deserve in record time. Our expert and collaborative billing team manages the complexities of medical billing through automated workflows, accurate verification processes, and clear reporting, enhancing workflow efficiencies and improving communication. Partnering with us reduces administrative burdens and enhances cost-effectiveness while ensuring compliance, professionalism, and greater clarity into your revenue cycle performance. So what are you waiting for? Act now and witness the difference firsthand.
Some distinctive rules govern the billing of California-based healthcare providers. Here is what our team manages for you amid the ever-changing billing rules:
As per the Medi-Cal provider manual, the claims under Medi-Cal must be received within the six months following the month of service. There are some exceptions for the delays. Our billing team tracks every encounter and builds a workflow that files claims within this limit.
Effective January 1, 2026, AB 3275 requires all California health plans and insurers to pay, contest, or deny claims within 30 calendar days. The rule applies uniformly, including to HMOs and Medi-Cal managed care plans, and late payers owe interest. We track every claim against the current rules and help you get paid.
California has two separate surprise-billing rules with two separate dispute paths. AB 72 covers state-regulated plans, while the federal No Surprises Act covers self-funded and other federally regulated plans. When an out-of-network payment dispute arises, our team identifies which rule applies and prepares the documentation for that process.
California plans must resolve disputes within 45 working days. We file disputes accurately, keep track of the deadlines, and escalate to regulators when necessary.
The requirements of California’s Confidentiality of Medical Information Act are stringent as compared to federal law. Our mechanism of communications follows both standards.
California is the only state where two regulators oversee the patient’s health plan. Department of Managed Health Care (DMHC) regulates most managed care enrollees, including the Medi-Cal managed care under the Knox-Keene Act. PPO and indemnity policies fall under the California Department of Insurance (CDI). Our experts verify these issues at the time of eligibility to ensure the dispute goes to the right place.
Patient's plan - Which regulator oversees it?
HMOs and most managed care, including Medi-Cal managed care
Knox-Keene Act rules
Disputes and complaints go through the plan's PDR process then the DMHC
Most PPO and indemnity insurance policies
Insurance Code rules
Disputes and complaints go to the California Department of Insurance
different dispute paths We identify the regulator at eligibility — so escalations land where they have teeth
Our billers and coders are knowledgeable about the unique payer mix in California. We work with:
Most Medi-Cal patients are enrolled in managed care plans under CalAIM, a Medicaid reform initiative. Each plan has its own portal and appeal windows. We take care of these things along with prior auth rules to verify and bill accurately.
The entity that pays for the medical claim is not the health plan in much of California. A delegated IPA (Independent Practice Association) or medical group under capitation pays for the claim. Mismanaging the route of these claims is one of the most common denial reasons. As a billing company in California, our experts manage these routes to help reduce claim denials.
We help you get reimbursed from major commercial payers like UnitedHealthcare, Kaiser, Health Net, Anthem Blue Cross, Blue Shield of California, Aetna, and Cigna.
We help you receive payments for Medicare Part B claims through California’s Medicare Administrative Contractor (MAC), with LCD-aware coding for coverage rules in the state of California.
We check your claims against the deadlines that matter in Texas and show you where revenue is slipping. Find out with a free billing audit.
Get a Free Claims ReviewOur medical billing services in California follow a more organized method so that errors can be minimized, claims can be paid accurately, and service providers can get their payments on time. Every step is considered carefully to ensure the revenue cycle performs well. We have developed a comprehensive process for all the procedural steps involved in CA medical billing.
To avoid delays or denials in billing, we collect patient information, validate insurance eligibility, and report any coverage issues as early as possible.
Our team of skilled coders analyzes the clinical records and applies the proper CPT and ICD codes to guarantee claim submission according to the relevant regulations.
Claims are checked and processed properly to ensure that they meet all payer requirements and claim submission is done promptly.
The process includes payment processing as well as adjustment and denial of claims and payments. The result is the creation of accurate records and the transparency of the financial health status of a practice.
Our dedicated team of accounts receivable experts finds the root cause of denials. They correct the claims and file appeals within the payer deadlines. Our experts pursue aging A/R until it is resolved.
With the aid of comprehensive reports and performance data, we enhance workflows, firm up collections, and optimize California healthcare medical billing processes.
Precision coding is critical in the reimbursement process. We have an accomplished team of coders certified by AAPC or AHIMA with rich experience in CPT, ICD-10-CM, and HCPCS coding protocols.
In addition, certified coding staff ensure that claims are reviewed accurately, which leads to fewer coding mistakes, reducing claim denials and complying with the dynamic rules of healthcare. Certified coders guarantee that every unit is coded correctly, thus maximizing the reimbursement possibilities and minimizing the risk of mistakes.
The importance of certified coders:
A Behavioral Health Practice's Journey to a Stable Revenue Cycle
Our team took over the practice's billing and credentialing, reviewed every open case individually rather than working from batch reports, and trained the practice's staff on current behavioral health coding rules. Billing went from a recurring problem to a managed process.
"I am impressed with their promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases, and with their willingness to educate me and my staff about the ever-changing rules of medical billing and the best use of coding. This is a company I trust with my billing needs."
— Dr. Neufeld, Practice Owner, FBH
Quick Comparison: Before and After MedCare MSO
| Metric | Before | After | Improvement |
|---|---|---|---|
| Collection Ratio | 75% | 90% | 15% plus |
| Revenue Increase | Baseline | 25% Increase | +25% |
| First-pass clean claims ratio | Below 80% | 90% | 10% plus |
| Denial Rate | High | Reduced by 40% | -40% |
Cardiology
Pulmonology
Hepatology
Hematology
Psychiatric
Traumatology
OB-GYN
Dermatology
Gastroenterology
Nephrology
Are you looking for a medical billing company in CA to streamline your revenue cycle? Look no further! Our medical billing and coding services are customized to meet the unique needs of each medical speciality. Our custom-tailored solutions align our services with your specific requirements, so you achieve maximum revenue-generating results.
Our medical billing company serves healthcare providers across California. We offer billing services in Los Angeles, San Francisco, San Jose, San Diego, Fresno, Sacramento, Long Beach, Oakland, Bakersfield, and Anaheim. From the Bay Area to the Inland Empire, we offer customized billing solutions based on California’s rules like 30-day prompt-pay and Medi-Cal’s six-month billing limit.
Los Angeles
San Francisco
San Jose
San Diego
Fresno
Sacramento
Long Beach
Oakland
Bakersfield
Anaheim
The Medi-Cal provider manual shows that the claims must be received within six months following the month of service. For instance, if the services are provided on January 15, the claim must be received prior to July 31 to avoid claim denial.
Under AB 3275, which took effect on January 1, 2026, the insurers and health plans in California must pay or deny claims within 30 days. It is a uniform rule for HMOs and Medi-Cal managed care plans. Our medical billing teams track every claim against every deadline.
The Department of Managed Health Care regulates HMOs and most managed care plans (including Medi-Cal managed care) under the Knox-Keene Act; the California Department of Insurance regulates most PPO and indemnity policies. Payment deadlines are now unified, but dispute and complaint processes differ. We identify the patient's regulator before filing disputes.
The financial responsibility for some services lies with IPA and capitated medical groups instead of health plans. This division determines the route of the medical claims in California. If it is sent to the wrong entity, it gets denied. We help maintain accurate routes of the medical claims to achieve maximum reimbursements.
Yes. We bill both fee-for-service Medi-Cal and the managed care plans that cover most Medi-Cal patients under CalAIM, each with its own portal, prior-authorization rules, and appeal deadlines.
We charge a percentage of collections. No setup fees and no hidden charges. Pricing depends on your claim volume and specialty; contact us for a customized quote.
We help you get paid inside California's deadlines and take Medi-Cal complexity off your plate. Request a free billing audit and find out where your revenue is leaking.
